September 09, 2019

Ebola preparations falter in war‑weary South Sudan

After vomiting blood and exhibiting fever – two of the virus’s telltale symptoms – the teenager had come to the Ebola isolation ward here in Yambio, a South Sudanese town near the border with the Democratic Republic of Congo.

But it wasn’t until he noticed Ebola posters hanging on the walls and medical staff in unusual scrubs that the shy boy – whose name has been withheld to protect his identity – realised why he had actually been confined. Nobody had thought to confirm it to him.

Lingering insecurity, a lack of funding, and issues with managing cases like the boy in Yambio are hampering efforts to prevent a possible outbreak of Ebola in South Sudan, according to health workers, government officials, and community leaders interviewed by The New Humanitarian.

With over 2,000 deaths in neighbouring Congo and at least four imported cases in recent weeks in Uganda, health experts say it is only a matter of time before the first cases emerge in South Sudan, where five years of conflict have left nearly 400,000 people dead, millions displaced, and brought an already weak healthcare system to its knees.

“Given the geographic proximity to – as well as population movements across – the border with Congo, it’s most probably not ‘if’ but ‘when’ South Sudan will see an imported case,” said Sudhir Bunga, South Sudan country director for the Centers for Disease Control and Prevention, the US health protection agency known by the initials CDC.

Funding gaps

South Sudan’s health ministry officials, together with international and local partners, have been preparing for a potential outbreak since Congo declared its epidemic last August – 32 screening points have been established in border towns and almost 3,000 frontline health workers have been vaccinated.

The country ramped up surveillance at some of its busiest crossings after a 41-year-old woman was discovered with Ebola in June in Ariwara, a Congolese town just 43 miles (70 kilometres) from the border.

Dr. Ali Ahmed Yahaya, a programme manager at the World Health Organisation, said there has been “significant progress”, such as establishing a new health emergency centre and a laboratory to test suspected cases.

Yet, despite more than a year of planning and preparation, the country’s war-weakened healthcare system is still struggling to keep up.

“No amount of preparedness is adequate for the country, given the nascent public health infrastructure,” said the CDC’s Bunga.

A lack of funding is also hampering efforts, according to Richard Lako from the South Sudanese government’s Ebola task force – $12 million was requested for the current round of Ebola preparations, but just 38 percent of that has been received so far.

Leaning his elbow on the wooden barrier that separates the green zone from the high-risk red area, the 15-year-old South Sudanese boy timidly asked the question that had been troubling him for days: “Do I have Ebola?”

Members of a rapid response team – whose job is to identify and monitor cases – have left their roles because they are not being paid, Lako said.

The challenge of preparing for Ebola can be seen most clearly in places like Yambio – a rural, conflict-hit border town where nine suspected cases of the virus have been isolated since February, including the 15-year-old mentioned above.

Insecurity from years of fighting has cut off direct access to neighbouring Uganda, forcing traders in Yambio to reroute through Congo’s Ituri province, which has seen more than 350 confirmed Ebola cases since the outbreak began in August last year. The majority of Congo’s more than 3,000 cases have been further south, in North Kivu province.

Poor case management

On a visit to Yambio last month, TNH witnessed a community struggling to prepare for the virus and health workers struggling to manage cases safely and effectively.

At Yambio’s Ebola isolation ward, four patients – two suspected cases and two contacts (people known to have had contact with suspected cases) – said it took around 24 hours for doctors to explain why they were being held in isolation.

A health worker involved in Ebola preparations, who wasn’t authorised to speak on the record, described the delay as “outrightly shocking”.

“Patients have a right to know why they are admitted, and they and their caregivers or family members must be made aware in real-time,” said the health worker. While doctors don’t want to panic people, there are ways to properly communicate the situation without hiding it from them, he added.

Patients suspected of having Ebola are also not being isolated properly.

After vomiting blood and showing signs of fever, 50-year-old John Henry said he spent a night at the state hospital in Yambio instead of being isolated, because there was no doctor on duty to tell them where to go. Henry tested negative for the disease, but if the results had been different more people would have been exposed to Ebola risk.

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After vomiting blood and exhibiting fever – two of the virus’s telltale symptoms – the teenager had come to the Ebola isolation ward here in Yambio, a South Sudanese town near the border with the Democratic Republic of Congo.

But it wasn’t until he noticed Ebola posters hanging on the walls and medical staff in unusual scrubs that the shy boy – whose name has been withheld to protect his identity – realised why he had actually been confined. Nobody had thought to confirm it to him.

Lingering insecurity, a lack of funding, and issues with managing cases like the boy in Yambio are hampering efforts to prevent a possible outbreak of Ebola in South Sudan, according to health workers, government officials, and community leaders interviewed by The New Humanitarian.

With over 2,000 deaths in neighbouring Congo and at least four imported cases in recent weeks in Uganda, health experts say it is only a matter of time before the first cases emerge in South Sudan, where five years of conflict have left nearly 400,000 people dead, millions displaced, and brought an already weak healthcare system to its knees.

“Given the geographic proximity to – as well as population movements across – the border with Congo, it’s most probably not ‘if’ but ‘when’ South Sudan will see an imported case,” said Sudhir Bunga, South Sudan country director for the Centers for Disease Control and Prevention, the US health protection agency known by the initials CDC.

Funding gaps

South Sudan’s health ministry officials, together with international and local partners, have been preparing for a potential outbreak since Congo declared its epidemic last August – 32 screening points have been established in border towns and almost 3,000 frontline health workers have been vaccinated.

The country ramped up surveillance at some of its busiest crossings after a 41-year-old woman was discovered with Ebola in June in Ariwara, a Congolese town just 43 miles (70 kilometres) from the border.

Dr. Ali Ahmed Yahaya, a programme manager at the World Health Organisation, said there has been “significant progress”, such as establishing a new health emergency centre and a laboratory to test suspected cases.

Yet, despite more than a year of planning and preparation, the country’s war-weakened healthcare system is still struggling to keep up.

“No amount of preparedness is adequate for the country, given the nascent public health infrastructure,” said the CDC’s Bunga.

A lack of funding is also hampering efforts, according to Richard Lako from the South Sudanese government’s Ebola task force – $12 million was requested for the current round of Ebola preparations, but just 38 percent of that has been received so far.

Leaning his elbow on the wooden barrier that separates the green zone from the high-risk red area, the 15-year-old South Sudanese boy timidly asked the question that had been troubling him for days: “Do I have Ebola?”

Members of a rapid response team – whose job is to identify and monitor cases – have left their roles because they are not being paid, Lako said.

The challenge of preparing for Ebola can be seen most clearly in places like Yambio – a rural, conflict-hit border town where nine suspected cases of the virus have been isolated since February, including the 15-year-old mentioned above.

Insecurity from years of fighting has cut off direct access to neighbouring Uganda, forcing traders in Yambio to reroute through Congo’s Ituri province, which has seen more than 350 confirmed Ebola cases since the outbreak began in August last year. The majority of Congo’s more than 3,000 cases have been further south, in North Kivu province.

Poor case management

On a visit to Yambio last month, TNH witnessed a community struggling to prepare for the virus and health workers struggling to manage cases safely and effectively.

At Yambio’s Ebola isolation ward, four patients – two suspected cases and two contacts (people known to have had contact with suspected cases) – said it took around 24 hours for doctors to explain why they were being held in isolation.

A health worker involved in Ebola preparations, who wasn’t authorised to speak on the record, described the delay as “outrightly shocking”.

“Patients have a right to know why they are admitted, and they and their caregivers or family members must be made aware in real-time,” said the health worker. While doctors don’t want to panic people, there are ways to properly communicate the situation without hiding it from them, he added.

Patients suspected of having Ebola are also not being isolated properly.

After vomiting blood and showing signs of fever, 50-year-old John Henry said he spent a night at the state hospital in Yambio instead of being isolated, because there was no doctor on duty to tell them where to go. Henry tested negative for the disease, but if the results had been different more people would have been exposed to Ebola risk.